COPE Internship: Care Navigator

Over the summer, I had the unique opportunity to participate in a pilot program from COPE: the Care/Patient Navigator Program. The program's focus is a shift away from the hospital setting to an out-patient or primary care setting, looking not at acute problems but chronic issues. The entire country, but Seattle in particular, has an issue of high Emergency Department utilization. Many people simply do not have primary care physicians, and as a result they go to the Emergency Department whenever they have any issue. These multiple occurrences place a huge burden on the health care system, and it does little to address the underlying cause of these peoples' issues, so they end up coming over and over again without actually getting better.

The Care Navigator was designed to be someone who could be a guide for these people through the health care system: figuring out what their socioeconomic situation is and helping them get the care they need. This might be in the form of scheduling appointments, making sure they have learning resources, or have adequate access to medications or methods to manage their health. For the Care Navigator program, I would be paired with a Preceptor who would assign me tasks to facilitate this process.

I got paired up with Nancy Rawlings, a veteran nurse who was now making discharge calls at Swedish Medical Group (SMG). After a patient had been discharged from the hospital, it was her duty to follow-up with them and make sure they understood their plan of care, made an appointment with a primary care physician, and that everything was okay in general. Nancy is just one of a few nurses responsible for exhaustive lists of these calls: they were backlogged about three months, and there were more piling on every day. As such, under her mentorship, I was responsible for going back through these lists, pulling up the patient's chart on the EPIC electronic medical record, and then synthesizing the information from their hospital stay into a "Chart Prep". Basically, I would begin the charting process that Nancy herself would later input into EPIC for when she made the actual call to the patient. This would save her a great deal of time and ensure she could call more patients. Also, I helped make her job more efficient by focusing her attentions where it needed to be. As mentioned, some people use the ED for fairly trivial reasons that don't merit a follow-up call, so if I wasn't sorting out these from the really serious ones, Nancy would have to call all of them.

This is what I really enjoyed about the Care Navigator program. It really felt like I was making a difference. I know that the work I do as a Health Scholar in the hospital is important, but actually being in the patient's charts, knowing that there would be an immediate effect on the health of the patient, it felt like I was doing some of the work that I would be as a doctor one day. Because of this, I found myself drawn to primary care for its actual merits. For so long, primary care had seemed more like a moral obligation than something I actually wanted to do. I've heard so much about how there's going to be a shortage of PCP's and that the population is only going to need more, so it seemed like the right area to specialize in. However, I joined the Care Navigator program because I'm invested in people, and I craved creating a long-term relationship with individuals to guide them towards life-long health rather than slapping on a band-aid and never seeing them again. The Care Navigator filled these expectations, and while I was working, I felt really invested in each and every case. Some people are disillusioned with the charting system, saying that it divorces the patient of their personality and doctors end up assuming they know everything about them. However, I think it really depends on the kind of person pulling up the chart. There is a significant amount of detail in the charts that goes beyond the superficial or physical, but really dives into how the patients are feeling, how they are presented emotionally. With a great bedside manner and the chart, I think a doctor could be a formidable healer.

In all honesty, I was a little disappointed with the Care Navigator program, but that's solely because of the administrative side of getting the program running. As a pilot or test cohort, there were many kinks to work out in terms of transitioning us into SMG, getting us paired with preceptors, and figuring out our curriculum. I was more than sad when I was told that the program was over just two months into it, and after really getting the hang of things with Nancy. However, even for the little time that I was in the program, I believe it was time really well spent. It was a wonderful learning experience. Professionally, I had to engage in a brand new setting. The administrative side of the hospital, the corporate headquarters of SMG, is impressive and I really had to hold my own in demeanor in a different way. It was tough not being intimidated, but I overcame it once I realized that everyone working there was still invested in patient well-being. We were doing the same work as in the hospital, just with nicer clothes on. The program was also really educational in terms of understanding the SCOPE OF HEALTH. The health issues we have may have a biochemical explanation, but how those issues arise extend beyond basic biology. We did this great exercise with a social worker from South Seattle who had us list a problem and then trace it back through stages. We discovered that no problem is one contained entity, but part of a stream of issues. In the context of the immense poverty, homelessness, and drug abuse that exists in Seattle, I felt like my eyes had been opened for the first time. I can't look at a patient anymore and just see their current diagnosis, I now find myself considering many aspects of their life background.

I hope the Care Navigator program can be implemented once more, because this I feel is the future of health care and where aspiring medical professionals need the most exposure. For more of my detailed experiences, refer to some of my journal entries located in Year III --> Summer 2015 --> Service: COPE Health Scholar.

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